Fisioterapia no paciente com asma: intervenção baseada em evidências
Physiotherapy in asthma patients: evidence-based intervention
Fernanda de Cordoba Lanza; Simone Dal Corso
Resumo
As intervenções fisioterapêuticas destacam-se como tratamento não farmacológico e são coadjuvantes no tratamento da asma. O tratamento fisioterapêutico só deve ser iniciado quando o indivíduo estiver com a medicação ajustada para sua condição e em acompanhamento médico regular. Como a asma é uma doença crônica com episódios recorrentes de sibilância, tosse e dispneia, ocorre aumento do trabalho respiratório e da percepção do esforço, podendo levar a alterações da mecânica respiratória, função muscular respiratória e do descondicionamento físico. Os objetivos da fisioterapia são: reduzir o desconforto respiratório e a dispneia, melhorar a mecânica respiratória, melhorar a força muscular respiratória nos casos de fraqueza desta musculatura, melhorar o condicionamento cardiorrespiratório, promover higiene brônquica, quando necessária, e melhorar a qualidade de vida. Estudos prévios investigaram os efeitos dos exercícios respiratórios, do treinamento muscular respiratório (TMR), da reabilitação pulmonar (RP) e das técnicas de higiene brônquica em pacientes asmáticos. Não há evidências de que os exercícios respiratórios melhorem a função pulmonar, embora reduzam os sintomas e a medicação de resgate e melhorem a qualidade de vida. O TMR diminui a dispneia, aumenta a força muscular inspiratória e melhora a capacidade de exercício. O treinamento físico, que é o principal componente da RP, leva à melhora dos sintomas respiratórios, da capacidade funcional e qualidade de vida. Por fim, não há evidências científicas que suportem a realização de técnicas manuais de higiene brônquica. No entanto, o oscilador oral de alta frequência pode ser uma estratégia para eliminar secreção de adultos e crianças na vigência de infecção pulmonar.
Palavras-chave
Abstract
Respiratory physiotherapy stands out as a nonpharmacological approach and is an adjuvant intervention in the treatment of asthma. Physiotherapy should only be initiated when the medication is adjusted to the patient’s condition and when the patient is under regular medical follow-up. Asthma is a chronic disease with recurrent episodes of wheezing, cough, and dyspnea, resulting in increased respiratory workload and perceived exertion and potentially leading to changes in respiratory mechanics, respiratory muscle function, and physical deconditioning. The objectives of respiratory physiotherapy are: to reduce respiratory distress and dyspnea, to improve respiratory mechanics and respiratory muscle strength (in cases of muscle weakness), to improve cardiopulmonary conditioning, to promote bronchial hygiene when necessary, and to improve quality of life. Previous studies have investigated the effects of breathing exercises, respiratory muscle training (RMT), pulmonary rehabilitation (PR), and bronchial hygiene techniques in patients with asthma. There is no evidence that breathing exercises can improve lung function, even though they reduce symptoms and the use of rescue medication and improve quality of life. RMT reduces dyspnea, increases inspiratory muscle strength, and improves exercise capacity. Physical training, the main component of PR, leads to improvement of respiratory symptoms, functional capacity, and quality of life. Finally, there is no scientific evidence supporting the use of manual bronchial hygiene techniques. Nevertheless, the use of oral high-frequency oscillators could be a strategy for mucus clearance in adults and children with pulmonary infection.
Keywords
References
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Submitted date:
01/10/2017
Accepted date:
02/15/2017
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